Cholesterol: should we screen all children or change the diet of all children.

Hypercholesterolaemia is a major risk factor for coronary heart disease and may present during childhood. Dietary measures can reduce plasma cholesterol and may thus delay or prevent the development of the atherosclerotic process. Although plasma cholesterol concentrations measured during childhood track into adult life with a correlation coefficient of about 0.6 this in itself is insufficient to justify total population screening of children especially as the mechanisms for management and follow-up and their social, psychological and economic implications have not been adequately evaluated. Targeted screening of children in families with the genetic disorder of familial hypercholesterolaemia, where the risk of premature coronary heart disease is very high, should, however, be undertaken even though such screening may only identify half of all affected children. Dietary change designed to lower plasma cholesterol can be applied to the whole population including children over the age of 2 years, does not require pre-determination of plasma cholesterol, and is to be recommended. The effects of such change on the growth and health of children should be monitored.